Carolyn Chang1, Sajjad Raza2, Salah E Altarabsheh3, Sarah Delozier2, Umesh M Sharma4, Aisha Zia5, Muhammad Shahzeb Khan6, Mandy Neudecker7, Alan H Markowitz2, Joseph F Sabik2, Salil V Deo8. 1. School of Medicine, Case Western Reserve University, Cleveland, Ohio. 2. Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 3. Department of Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan. 4. Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, Minnesota. 5. Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 6. Division of Internal Medicine, Cook County Hospitals, Chicago, Illinois. 7. Medical Librarian, Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 8. Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Electronic address: svd14@case.edu.
Abstract
BACKGROUND: Limited data exist studying the outcomes of the 2 minimally invasive aortic valve replacement (AVR) strategies-mini-sternotomy (AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect meta-analysis to compare the outcomes of these minimally invasive approaches with each other and with conventional AVR (cAVR). METHODS: We Searched Medline, PubMed, Embase, and Web of Science in December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical outcomes were compared between cohorts with inverse weighted random effects modeling. Endpoints studied included hospital mortality, stroke, atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of stay. RESULTS: A total of 19 studies (>10,000 pooled patients) met the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were comparable between minimally invasive and conventional AVR. CPB times were longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p < 0.01). In the AVR-th cohort, CPB duration was weakly inversely related to study size (p = 0.06). Atrial fibrillation was much less after AVR-th (odds ratio 0.47 [0.35 to 0.63]; p < 0.001). Hospital stay was significantly lower after minimally invasive surgery (0.8 [0.4 to 1.3] days; p < 0.01). AVR-th patients were dismissed 2.1 (1.6 to 2.7) days earlier than cAVR patients. CONCLUSIONS: Minimally invasive approaches to AVR yield excellent outcomes in high-volume centers. They reduce hospital stay and incidence of postoperative atrial fibrillation, and therefore should be considered in patients undergoing AVR. The operative approach should be selected according to surgeon's technical expertise and what is best for specific patient profile, however.
BACKGROUND: Limited data exist studying the outcomes of the 2 minimally invasive aortic valve replacement (AVR) strategies-mini-sternotomy (AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect meta-analysis to compare the outcomes of these minimally invasive approaches with each other and with conventional AVR (cAVR). METHODS: We Searched Medline, PubMed, Embase, and Web of Science in December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical outcomes were compared between cohorts with inverse weighted random effects modeling. Endpoints studied included hospital mortality, stroke, atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of stay. RESULTS: A total of 19 studies (>10,000 pooled patients) met the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were comparable between minimally invasive and conventional AVR. CPB times were longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p < 0.01). In the AVR-th cohort, CPB duration was weakly inversely related to study size (p = 0.06). Atrial fibrillation was much less after AVR-th (odds ratio 0.47 [0.35 to 0.63]; p < 0.001). Hospital stay was significantly lower after minimally invasive surgery (0.8 [0.4 to 1.3] days; p < 0.01). AVR-th patients were dismissed 2.1 (1.6 to 2.7) days earlier than cAVR patients. CONCLUSIONS: Minimally invasive approaches to AVR yield excellent outcomes in high-volume centers. They reduce hospital stay and incidence of postoperative atrial fibrillation, and therefore should be considered in patients undergoing AVR. The operative approach should be selected according to surgeon's technical expertise and what is best for specific patient profile, however.
Authors: Martin Andreas; Paolo Berretta; Marco Solinas; Giuseppe Santarpino; Utz Kappert; Antonio Fiore; Mattia Glauber; Martin Misfeld; Carlo Savini; Elisa Mikus; Emmanuel Villa; Kevin Phan; Theodor Fischlein; Bart Meuris; Gianluca Martinelli; Kevin Teoh; Carmelo Mignosa; Malakh Shrestha; Thierry P Carrel; Tristan Yan; Guenther Laufer; Marco Di Eusanio Journal: Eur J Cardiothorac Surg Date: 2020-11-01 Impact factor: 4.191